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Continuous & Integrated Drought Management Health Component

Continuous & Integrated Drought Management Health Component. Dr. Bela Shah, ICMR Dr. R. C. Sharma Desert Medicine Research Centre JODHPUR. dmrc Desert Medicine Research Centre. Network of ICMR Institutes. Rajasthan. India. IGNP. DMRC Current Programmes. Dengue RF/RHD registry

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Continuous & Integrated Drought Management Health Component

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  1. Continuous & Integrated Drought ManagementHealth Component Dr. Bela Shah, ICMR Dr. R. C. Sharma Desert Medicine Research Centre JODHPUR dmrc Desert Medicine Research Centre

  2. Network of ICMR Institutes

  3. Rajasthan India IGNP

  4. DMRCCurrent Programmes Dengue RF/RHD registry Malaria Diabetes Tuberculosis Hypertension Nutrition Musculoskeletal disorders Emphasis on: Focused research of relevance to Public Health dmrc Desert Medicine Research Centre

  5. Micronutrient deficiency disorders, Nutritional Status & morbidity in pregnant & lactating women 28 villages from Luni Panchayat Samiti, Jodhpur tehsil Covered 1193 women- 384 Pregnant women 400 Lactating women 409 NPNL women (Control)

  6. Iron Deficiency: Hemoglobin levels Iodine deficiency disorder: UIE levels (WET digestion method) Iodine content of salt sample (standard iodometric titration method) Nutritional deficiency signs & Morbidities Dietary pattern (24 hour recall method)

  7. Iron Deficiency Disorder (Figures are in percent)

  8. Iodine Deficiency Disorder Figures are in percent

  9. Major Nutritional Deficiency Signs Pregnant Controls n=384 n=409 VAD-Night blindness 8.8 % 0.9 % Thyroid enlargement 3.1 % 0.5 %

  10. Dietary Intake Pregnant & lactating women • Percent of RDA • Cereals consumption 79 • Fats & Oils 80 • Pulses & legumes 56 • Leafy Vegetables 9.5 • Milk & Milk foods Adequate • n=148

  11. Dietary Deficiencies • Protein (20%) & Calories 40 % • Iron (36%) & Folic Acid 57 % • IFA tablets consumption–43 % • Consumption of Iodized salt- 19.1 %

  12. Nutrition Monitoring • Jodhpur District • 30 villages from six Tehsils • Covering 600 households

  13. Nutritional deficiency signs Anthropometric measurements Ht, Wt, MUAC & FFT Dietary intake-24 hour recall method Nutritional morbidities

  14. Major Nutritional Deficiency Signs • n=3540 • Dental caries- 31.2 % • Dental Fluorosis- 25.2 % • Hair Discolouration- 6.0 % • Gums spongy/bleeding- 2.6 %

  15. Nutritional Morbidities • n=3540 • ARI - 5.4 % • Fever - 4.5 % • Diarrhea - 1.1 % • N.A.D. - 88.7 %

  16. Nutritional Status Preschool children 1-5 (n=553) Grades Normal Mild Moderate Severe Under Nutrition18.6 27.3 15.9 38.2 (Wt for age) Stunting 28.4 14.8 56.2 (Ht for age) Adults Obesity Normal CED I CED II CED III n=1148(BMI) 7.8 57.2 18.7 9.1 7.2

  17. Dietary Deficiencies • (n=1565) • Diet grossly deficient in GLV - 91.0 % • Fats - 55.0 % • Pulses & legumes - 59.5 % • Other Vegetables - 35.0 % • Cereals - 20 % of RDA

  18. Sub-Clinical Vitamin-A Deficiency among children of Rajasthan A UNICEF sponsored multi centric and cross sectional study • Covering seven districts of Rajasthan from seven different agro-climatic zones • Sample Size: 3000 children(6-71 months) from Rural and Urban areas

  19. Nutrition Research focus: • - Nutrition atlas for Desert • - Monitoringof Nutritional Deficiencies and • associated morbidities • - Development of Nutritional intervention package considering Socio-behavioural & cultural aspects dmrc Desert Medicine Research Centre

  20. Projects Proposed • Fortification of wheat & millet flour with iron along with • double fortification in salt & their impact on nutrition status • of preschool children DBT-NIN networking • Development of nutrition package for Micronutrient • deficiencies & its impact assessment on pregnant & lactating • women • Impact assessment of consumption of three electrolyte • products on mineral profile & general health profile of • Jawans in desert areas of RajasthanDFRL,Mysore • Estimation of Zinc def. in school children

  21. Expertise • Medical anthropologists • Clinicians • Social scientists • Trained Technicians

  22. Infra structure • Anthropometric equipments for Anthropometry • Dietary cups, balances etc for Dietary intake • Colorimeter, spectrophotometer & HPLC for biochemical analysis of MDDs (Iron, Iodine, Vitamin A)

  23. Suggested Monitoring Crude Mortality-Secondary & Primary Acute Malnutrition } Anthropometry Chronic Malnutrition } Food Access /Availability } Dietary Dietary Diversity } Intake

  24. Target Group • Pregnant Women • Preschool children

  25. Monitoring Parameters • Nutritional status: • Anthropometry • Dietary Intake • Nutritional deficiency signs • Biochemical tests Outcome of pregnancy: • Abortions • Still Birth • Under weight new born

  26. Impact of Under-Nutrition • Under weight children • Anemic mothers • Marasmic babies • Vitamin A deficiency blindness • Vitamin B deficiencies • Vitamin C deficiencies

  27. Monitoring Parameters • Anthropometry • Acute Malnutrition: Weight / Height • (Wasting)Weight / Age • Chronic Malnutrition: Height / Age • (Stunting) • Dietary Intake • 24 hour recall method: Food Access • Food Availability • Food Diversity

  28. Nutritional Deficiency Signs • Protein-energy malnutrition • Popn. Group Clinical Symptoms / Signs • Children Always present • Marasmus Wasting • Kwashiorkar Oedema • MarasmicWasting + Oedema • Kwashiorkar • Adults Wasting & weakness

  29. Nutritional Deficiency Signs • 2. Anemia - Pallor (palms, Tongue, conjunctiva) • 3. Vitamin A deficiency • (XN) Night blindness • (X1A) Xerosis of conjunctiva • (X1B) Bitot spot • (X2) Xerosis of cornea • (X3A) Xerosis of cornea + ulcer • (X3B) Keratomalacia • (XS) Corneal scar + history of VAD

  30. Nutritional Deficiency Signs • 4. Vitamin B complex deficiency • 1. Riboflavin (B2) & Pyridoxine (B6) deficiency • Angular stomatitis • Chelosis • Glossitis • 2. Thiamin deficiency (B1) • Beriberi* • 3. Nicotinic acid deficiency (B2) • Pellagra*

  31. Nutritional Deficiency Signs • 5. Vitamin C deficiency- Scurvy • Fluoride- Dental Caries Dental Fluorisis • 7. Iodine deficiency disorders - Goiter Cretinism

  32. Response • DMRC proposes to participate and share responsibility in efforts towards • 1.Development of socioeconomic drought monitoring indicators and • 2. Impact assessment of mitigating measures on five parameters Crude Mortality, Acute Malnutrition, Chronic Malnutrition, Food Access /Availability, • Dietary Diversity

  33. THANKS dmrc Desert Medicine Research Centre

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